Self-Inflicted Deaths Among Women With U.S. Military Service: A Hidden Epidemic?

Prospective analyses of National Health Interview Survey and National Death Index data found an adjusted risk of suicide among male veterans twice that of nonveteran males (1). That study also examined data for 11 female veterans and 246 female nonveterans who completed suicide and found that women with past military service were more likely to complete suicide (adjusted hazard ratio=3.62, 95% confidence interval [CI]=1.95–6.73)

New Iraqi women soldiers pose after their graduation ceremony in Jordan's Military Academy in Zarqa

This cross-sectional study used 2004– 2007 data for 5,948 women (ages 18 to 64) who completed suicide in the 16 states that constitute the National Violent Death Reporting System. Denominators were from 2004–2007 veteran population data and American Community Surveys. We examined rates for female nonveterans and veterans, whose rates were computed using two denominators—female veterans and the broader military service population of veterans plus active duty, reserve, and National Guard.

Figure 1 shows standardized mortality ratios (SMRs) for female veterans, who were more likely than nonveterans to complete suicide, even when the broader military service denominator was used (ages 18–34, SMR= 1.76, CI=1.32–2.27 and ages 35–44, SMR=1.30, CI=1.00–1.66).

As the first general population study of current suicide risk among women with U.S. military service, limitations included inability to distinguish decedents on active duty versus those who were discharged, presumed undercounting of suicides, absence of data on military sexual trauma or combat exposure, and unavailable data on possible confounders (which were addressed in longitudinal analyses).

These findings suggest a hidden epidemic of suicide among younger women with military service. Clinicians should inquire about military service among women and should recognize that suicide prevention practices
pertain to female veterans.

Authors are Bentson H. McFarland, M.D., Ph.D., Mark S. Kaplan, Dr.P.H., Nathalie Huguet, Ph.D. Dr. McFarland is affiliated with the Department of Psychiatry, Oregon Health and Science University. Dr. Kaplan and Dr. Huguet are with the School of Community Health, Portland State University, Portland, Oregon. Amy M. Kilbourne, Ph.D., M.P.H., and Tami L. Mark, Ph.D., are editors of this column.

Young women veterans are nearly three times as likely as civilians to commit suicide according to new research published by researchers at Portland State University (PSU) and Oregon Health & Science University (OHSU).

The paper “Self-Inflicted Deaths Among Women With U.S. Military Service: A Hidden Epidemic?” appears in the December 2010 journal Psychiatric Services, published by the American Psychiatric Association. This work is the first general population study of current suicide risk among women with U.S. military service.

According to the data, female veterans between the ages of 18 and 34 are at highest risk.

“Women veterans are more likely to complete suicide than non-veteran women,” said Bentson McFarland, M.D., Ph.D., a professor of psychiatry in the OHSU School of Medicine. McFarland co-authored the paper with Mark Kaplan, Dr.P.H., and Nathalie Huguet, Ph.D., of Portland State University.

“The rate was lower in the next oldest age group we studied (35 to 44 years of age) and the rate was lower still among those ages 45 to 64. However, even within this age group, the rate was higher than civilian women’s suicide rates.”

The study examined data on 5,948 female suicides committed between the years 2004 and 2007. In the 18 to 34 age group alone, there were:
• 56 suicides among 418,132 female veterans (1 in 7,465);
• 1,461 suicides among 33,257,362 nonveterans (1 in 22,763).

“This study shows that young women veterans have nearly triple the suicide rate of young women who never served in the military,” said Mark Kaplan, co-author of the study and professor of Community Health at PSU. “The elevated rates of suicide among women veterans should be a call-to-action, especially for clinicians and caregivers to be aware of warning signs and helpful prevention resources such as the Veterans Suicide Prevention Hotline [1-800-273-TALK (8255) press “1”].

The research, funded by the American Foundation for Suicide Prevention, was conducted by tracking suicide data in the 16 states that constitute the National Violent Death Reporting System, a program within the Centers for Disease Control and Prevention at the U.S. Department of Health and Human Services.